McFarland Daniel C, Maki Robert G, Holland Jimmie
Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, One Gustave L Levy Place, Box 1079, New York, NY 10029, USA.
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Med Sci Educ. 2015 Dec;25(4):413-420. doi: 10.1007/s40670-015-0159-x. Epub 2015 Jul 25.
Effectively managing patient distress in oncology is challenging. Trainees in oncology experience distress along with their patients and patients' families, especially during an inpatient admission. This study evaluated the physician-in-training experience while working on an inpatient hematology-oncology ward.
We collected a survey from internal medicine interns and residents at the end of a 2- or 4-week-long rotation on a hematology-oncology ward. It included the Impact of Events Scale-Revised (IES-R), a measure of distress, information about resident demography, rotation experiences with death, and personal circumstances that could affect distress levels. House officers were asked to provide comments regarding their most stressful experiences or how they were affected by dying patients.
Fifty-six residents completed questionnaires (58 % overall response rate) and scored IES-R 18.7 (SD 14.2) indicating that the majority (80 %) experienced significant clinical distress (IES-R ≥8) and 20 % experienced posttraumatic stress disorder (PTSD) levels of distress (IES-R ≥33). Comment themes are highlighted and included general frustration and death-related events. Forty-one (73 %) reported that their IESR was a death-related experience, and 39 (69.6 %) reported that attending to dying patients was the part of the rotation. Residents cared for 4.28 patients at the end of life on average during the rotation, and 68 % derived a sense of meaning from such work.
This study suggests that physician-trainee distress is significantly elevated while working on a hematology-oncology ward and may relate to general frustration and death-related events. Further study should evaluate the etiology of medical trainee distress in oncology.
有效管理肿瘤患者的痛苦具有挑战性。肿瘤学实习生与患者及其家属一同经历痛苦，尤其是在住院期间。本研究评估了在血液肿瘤内科病房工作的住院医师培训经历。
我们在血液肿瘤内科病房进行为期2周或4周的轮转结束时，收集了内科实习生和住院医师的调查问卷。问卷包括事件影响量表修订版（IES-R），用于衡量痛苦程度，还包括住院医师人口统计学信息、与死亡相关的轮转经历以及可能影响痛苦程度的个人情况。要求住院医师就他们最有压力的经历或他们如何受到濒死患者的影响发表评论。
56名住院医师完成了问卷调查（总体回复率为58%），IES-R评分为18.7（标准差14.2），表明大多数（80%）经历了显著的临床痛苦（IES-R≥8），20%经历了创伤后应激障碍（PTSD）水平的痛苦（IES-R≥33）。评论主题得到突出，包括普遍的挫败感和与死亡相关的事件。41人（73%）报告称他们的IES-R是与死亡相关的经历，39人（69.6%）报告称照料濒死患者是轮转的一部分。住院医师在轮转期间平均照料4.28名临终患者，68%的人从这项工作中获得了意义感。
本研究表明，在血液肿瘤内科病房工作时，住院医师培训学员的痛苦显著增加，可能与普遍的挫败感和与死亡相关的事件有关。进一步的研究应评估肿瘤医学实习生痛苦的病因。
